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Enrolllment is Open
Student Application
Please fill out the application information below to enroll in the Health and Wellness training course
Student Application Form
Note: *
indicates required information
Select the date
August 25, 2022-Thursday, Friday and Saturday (Time TH and Fri. 6-8:30 P.M., Sat. 8-10 A. MST) 9-week program
Hold My Seat (Deposit)
September 12, 2022- Mon. Tues. & Wed. 6-8:30 P.M. MST. (9 week course)
Personal Details
Professional Details
Please select one
Physician
Nurse Practitioner
Physical Therapist
Chiropractor
Dietitian
Nutritionist
Health Coach
Personal Trainer
none
Education
Please select one
High School
GED
Associate
BS/BA
Masters
PHD
MD/DO
Other
Credentials
I agree to the Nutrition Factors Terms and Conditions, Business Associate Agreement (BAA) and Affiliate Program Agreement *
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